Provider Demographics
NPI:1669860193
Name:COOPERATIVE EDUCATIONAL SERVICE AGENCY 2
Entity type:Organization
Organization Name:COOPERATIVE EDUCATIONAL SERVICE AGENCY 2
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARLASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-473-1447
Mailing Address - Street 1:1221 INNOVATION DRIVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WHITEWATER
Mailing Address - State:WI
Mailing Address - Zip Code:53190
Mailing Address - Country:US
Mailing Address - Phone:262-473-1473
Mailing Address - Fax:262-472-2269
Practice Address - Street 1:17 S RIVER STREET
Practice Address - Street 2:#100
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548
Practice Address - Country:US
Practice Address - Phone:608-741-6687
Practice Address - Fax:608-756-1288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care